Ahmad Najdat Bazarbashi, MD1, Benjamin N. Smith, MD2, Christopher C. Thompson, MD, MHES3
1Brigham and Women's Hospital, Somerville, MA; 2Brigham and Women's Faulkner Hospital, Boston, MA; 3Brigham and Women's Hospital, Boston, MA
Intragastric balloons (IGB) are commonly being used for the treatment of obesity, with increasing data confirming their effectiveness. While usually well tolerated with rare adverse events, IGBs have been associated with complications including visceral perforation, pancreatitis and bowel obstruction. IGB hyperinflation, which occurs due to an abnormal accumulation of gas within IGB is rare. We present a case of a patient with abdominal pain and vomiting after recent IGB placement, found to have a palpable abdominal mass.
Case Description/Methods: A 35-year-old female with class II obesity (BMI: 33kg/m2) and recently placed adjustable IGB in the Dominican Republic presented to our emergency department with abdominal fullness, vomiting and inability to keep food down. The IGB had been placed for two months with reported 30lbs weight loss. She denied fevers, dysphagia, hematemesis, melena or altered bowel movements.
She was afebrile with normal vital signs. Physical examination revealed a palpable round-like mass in her epigastric region with tenderness to palpation. Laboratory workup, including complete blood count, basic metabolic panel, liver function tests and lipase were normal. CT scan of the abdomen and pelvis revealed a gas-filled hyperinflated IGB within the distal portion of the stomach with dilation proximally representing possible gastric outlet obstruction. There was no evidence of perforation or pneumatosis intestinalis [Figure 1A-C]. Due to her symptoms, and the patient’s wishes to have the balloon removed, endoscopy was performed.
Endoscopy revealed a hyperinflated, adjustable IGB occupying two thirds of the gastric body and obstructing the gastric antrum. The balloon appeared mottled suggesting fungal colonization from the outside with food debris. Attention was then placed on balloon removal. Successful removal of 500cc of blue-colored fluid mixed with air was performed resulting in IGB deflation and subsequent retrieval. The patient did well with resolved symptoms and was discharged the next day.
Discussion: Intragastric balloon hyperinflation should be recognized as a possible complication of IGB placement and may be due to balloon permeability or gas-producing anaerobic bacteria. Patients usually present with nausea, vomiting and inability to tolerate oral intake and if left untreated can result in dire consequences. Imaging may assist with diagnosis. Treatment involves endoscopic IGB removal. In cases of adjustable IGB, deflation and fluid exchange can be considered.
Citation: Ahmad Najdat Bazarbashi, MD; Benjamin N. Smith, MD; Christopher C. Thompson, MD, MHES. P2698 - INTRAGASTRIC BALLOON HYPERINFLATION: A RARE CAUSE OF A PALPABLE ABDOMINAL MASS. Program No. P2698. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.